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Oral Surgery > LA > Flashcards

LA Flashcards

1
Q

Briefly explain the process of depolarization

A

Na+ enters cell, K+ leaves cell

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2
Q

What is the mode of action of LA agents:

a) Alter resting potential of cell membrane
b) Alter threshold potential
c) Decrease rate of depolarization
d) Prolonging the phase of depolarization

A

c) Decrease the rate of depolarization to a level which becomes too slow to reach threshold of action potential

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3
Q

Which is able to diffuse across membrane:

a) ionic particles
b) Non-ionic particles

A

Non ionic

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4
Q

The preferred LAs used in clinical practices are

a) Esters
b) Amides

A

b) Amides

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5
Q

Which of these does not contain adrenaline

a) Lignocaine
b) Mepivacaine
c) Prilocaine
d) Articaine

A

Prilocaine

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6
Q

Where is Articaine metabolised?

A

Liver and Plasma

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7
Q

Duration of Lignocaine with Adrenaline:

A

60-90 mins

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8
Q

Lignocaine is excreted by the:

A

Kidneys

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9
Q
A
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10
Q

What is the spposed advantage of mepivacaine over lignocaine?

A

Longer lasting as less vasodilator effect

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11
Q

Priolocaine is metabolised in the and excreted in.

A

Lungs and Liver

Urine

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12
Q

Prilocaine is implicated in the formation of:

It is therefore contraindicated in:

A

Methaemaglobin

Pregnant

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13
Q

What is used to reverese methamaglobinaemia

A

Methylene blue

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14
Q

Why is articaine thought to be less toxic than lignocaine?

A

Shorter half life

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15
Q

Articaie is not recommended for whom:

A
  • Pregnant
  • Under 4
  • Sulphur allergy
  • Pseudocholinesterase deficiency
  • Methaemogobinaemia
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16
Q

Articaine is metabolised by:

A

Liver, lung, plasma

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17
Q

Which is not used in routine dentistry:

a) Mepivacaine
b) Articaine
c) Bupivicaine
d) Lignocaine

A

c) Bupivacaine

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18
Q

How is LA dosage calculated?

A

LA% x cartridge volume x 10

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19
Q

What is the absolute maximum safe dose of Lignocaine

A

500mg

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20
Q

What is the absolute maximum safe dose of articaine?

A

700mg

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21
Q

What is the maximum recommended safe dose of Lignocaine per kg body weight:

A

7.0mg

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22
Q

Adrenaline is a

a) Bronchoconstrictor
b) Bronchodilator

A

b) Bronchodilator

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23
Q

What effects does adrenaline have on the heart

A
  • Increase rate and contractility eg cardiac output
  • Increased workload and oxygen demand
  • May induce angina or arrhythmias in susceptible patients
  • May also increase blood pressure
  • MUST USE PRECAUTION if someone is being prescribed non-selective beta blockers
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24
Q

The maximum recommended adrenaline dose for healthy patients is:

A

0.2mg

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25
Q

Maximum recommended dose of LA for cardiac patients is:

A

2x 2.2ml cartridges

26
Q

Adrenaline in LA may interact with what drugs:

A
  • MAOIs
  • TCAs
27
Q

Is it prilocaine or felylpressin which is an issue for pregnant women

A

prilocaine

28
Q

what is the recommended needle gauge

A

27g

29
Q

What conditions should patients not be reclined

A

Heart failure

Third trimester pregnancy

30
Q

Why are posterior superior alveolar nerve blocks not recommended?

A

Pterygoid venous plexus in this location, risk of haematoma and cavernous sinus thrombosis

31
Q

What nerve supplies the buccal mucosa of the lower incisors, canines and premolars?

A

Mental nerve

32
Q

What nerve supplies the buccal mucosa to the first, second and third molars

A

Long buccal nerve block

33
Q

What space are IDBs injected into?

A

Pterygomandibular space

34
Q

What borders the pterygomandibular space superiorly

A

Lateral pterygoid muscle

35
Q

What borders the pterygomandibular space medially?

A

Medial pterygoid muscle

36
Q

What borders the pterygomandibular space posteriorly

A

Parotid gland

37
Q

What borders the pterygomandibular space anteriorly

A

Buccinator

38
Q

What is the volume of the pterygomandibular space?

A

2ml

39
Q

The pterygomandibular space is located in the lower part of the .

A

Infra-temporal fossa

40
Q

Which structure is not contained in the parotid gland

a) Facial nerve
b) External carotid artery
c) Internal carotid artery
d) Retromandibular vein

A

c) Internal carotid artery

41
Q

What attaches to the Pterygoid hamulus

A
  • Buccinator
  • Superior pharyngeal constrictor
42
Q

When might a Periodontal ligament injection be the primary indication for LA

A

Patient has a bleeding problem

43
Q

When won’t a periodontal ligament injection work

A

inflammation

44
Q

If a patient has had MI or heart failure in last 6 months, pain relief should be opted for over tx

True or false

A

True

45
Q
A
46
Q

5 complications of LA

A
  • Failure to achieve LA
  • Local complications eg breakages
  • Overdose
  • Spread of infection
  • Allergic reaction
  • Pain, bruising, trismus, haematoma, lip biting, oedema
47
Q

What to do about persistent anesthesia or paraesthesia:

A

Usually resolves in 8 weeks, but in rare cases may be permanent.

Discuss with maxfac if no improvement.

48
Q

5 causes of persistent anesthesia or paraesthesia following LA:

A
  1. Trauma to nerve sheath eg barbed needles or hitting it
  2. Contaminated LA
  3. Oedema in the pterygomandibular space
  4. LA toxic damage to nerve
49
Q

What might cause trismus following LA

A
  • Trauma to the medial pterygoid muscles
  • Bleeding in the pterygomandibular space
  • Injection into the medial pterygoid
  • Contaminated LA or excessive volumes
  • Low grade infection
50
Q

MAangement of trismus following LA:

A

Reassure. Advise 5 days of rest then mouth opening exercise and advise use of sugar free chewing gum.

If not improvement in 6 weeks, Maxfax referral

51
Q

What would cause a haematoma during LA

A

Inadvertent nicking of blood vessels

Frequently seen in pts with haemostatic disorders or on blood thinning medications

52
Q

Management of haematoma if you see it immediately

A

Ice.

Advice re trismus and discomfort.

Apply heat form the following day

53
Q

Management for lip chewing injury:

A
  • Analgesics
  • Lukewarm salt water/chlorhex rinse
  • Vaseline to minimize irritation
  • Instructions
  • Short acting LA next time
54
Q

How long will a facial nerve paralysis from LA last?

A

About 2 hours

55
Q

What might cause an ulcer at site of injection?

A

Apthous stomatitis or viral cause. Rare.

56
Q

What might cause blanching of the facial skin following LA

A

Injected into artery. Transient.

57
Q

What might cause a patient to become temporarily blind or blurred vision following LA

A

Abnormal anastomosis and injected into inferior dental artery. close to infra-orbital fissure

58
Q

Patient presents to clinic 3-4 hours following dental procedure, with central cyanosis and respiratory distress. You exo’d teeth under prilocaine. What might be the cause.

A

Overdose of Prilocaine (over 400mg) leading to methaemoglobinaemia

(can also happen with benzocaine overdose)

59
Q

What is the safe total dose of lignocaine 2% per kg. body weight.

A

4.4mg per kg body weight

60
Q

What is the max safe dose of lignocaine 2%

A

300mg

61
Q

What is a hot tooth?

A

A tooth with pulp inflammation causing hyperalgesia

62
Q
A

Oral Surgery (7 decks)

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